MEDICARE: DR. JOHN BOYLE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	JB014559	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7755470	OTHER	MI	AETNA
3	350F375630	OTHER	MI	BCBSM
4	3008001	OTHER	MI	CIGNA
5	383379540	OTHER	MI	TAX ID

General Provider Information

NPI Number	:	1669470035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BOYLE DO

Provider Business Mailing Address
First Line	:	2300 HAGGERTY RD
Second Line	:	SUITE # 2110
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2184
Country	:	US
Telephone Number	:	248-926-1411
Fax Number	:	248-926-5338

Provider Business Practice Location Address
First Line	:	2300 HAGGERTY RD
Second Line	:	SUITE # 2110
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2184
Country	:	US
Telephone Number	:	248-926-1411
Fax Number	:	248-926-5338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	02/13/2009

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Directions to “ DR. JOHN BOYLE DO” Practice Location

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